Transcription:
Sudden Cardiac Arrest

Maggie McKay (Host): Welcome to Hello Healthy. I'm your host, Maggie McKay. Have you ever had chest pains and wondered if you're having a heart attack? It can be scary to say the least, especially if your family has a history of heart health issues. But if you know the signs and possible risk factors involved, that knowledge could possibly save your life or somebody else's.

Today, we're going to talk about sudden cardiac arrest, what it is, the symptoms, what you need to do if you experience it and more. Joining us is Dr. Jared Salvo, an Electrophysiologist and Director of the Electrophysiology Lab at Bakersfield Memorial Hospital, a Dignity Health Hospital. Thank you so much for being here, Dr. Salvo, to talk about sudden cardiac arrest. We appreciate your time.

Jared Salvo, M.D. (Guest): Thank you for having me. It's my pleasure to be here, to talk about something that's so important. And probably underrepresented, as we discuss health care in general.

Host: Absolutely. February is Heart Health Month, but anytime we can shine a light on this topic is a good time. Why is it important to bring awareness to cardiovascular health?

Dr. Salvo: Well, it's an excellent question. The answer really lies in the numbers and cardiovascular disease is the number one, all cause mortality event that will, you know, if you look at the numbers in America, it is the most common cause of death, from health-related episodes. And especially in light of the last two years with the pandemic. A lot of folks really put their preventative care and typical cardiac care on the back burner. And so it was important, the month of February and quite frankly, any time to bring this back to the forefront, because while the coronavirus was grabbing all the attention and headlines, it doesn't mean that our other chronic diseases like cardiovascular disease were taking a nap. They were actually still there and quite problematic. What we found was a lot of folks neglected these conditions and now that we're coming out of it, especially in February and onward, we're discovering that there's a lot of decompensation in these chronic conditions in our folks out there.

Host: Wow. So, what is sudden cardiac arrest?

Dr. Salvo: So the sudden cardiac arrest is sudden electrical death of the heart. The heart is an electrically active organ and it beats by itself. It doesn't need the body to tell it to beat, it's automatic, but there are certain conditions that can lead to electrical death of the heart. And this is not a blood clot. It is not a blocked artery. It's not a heart attack. This is where the heart essentially quivers and does not pump blood. And unfortunately the most common symptom of sudden cardiac arrest is death. But if we identify things that can prevent cardiac arrest, we can be proactive about it and prevent catastrophe from happening. You've probably heard things like automated external defibrillators, and you'll see those at airports and at shopping malls and at gymnasiums, and those are really designed to act very quickly to resuscitate someone if they have a cardiac arrest.

In other folks, if we can identify that they have a weakened heart where the pump is not strong, then we can preventatively implant them with a defibrillator that resuscitates them immediately if they should have sudden cardiac arrest. Unfortunately, if you're predisposed to having a cardiac arrest, there are sometimes not a lot of medications that can prevent it. But the trick is to really be prevented to keep yourself out of trouble before you get to the risk of sudden cardiac arrest.

And what I'm talking about is a weakened heart. We don't care if your heart is weak because a virus attacked it, or you've had a lot of heart attacks, or maybe it's from a congenital inherited condition, or even sometimes things that we do to our body like drinking excessive alcohol. When the heart muscle gets weak, it's prone to having this quivering, unsteady, deadly heart rhythm. So going back to preventative care, I would recommend that patients understand what their risks are. Are there family history? Are there signs that their heart is starting to weaken? And are there things that they can do such as taking medications or changing lifestyle to prevent them from developing a weakened heart. Once the heart has reached a critically low pump status, that's when you really become at risk and you have to take these more aggressive measures, like implanting a defibrillator, or hopefully not depending on a bystander to open a defibrillator at a gymnasium or at an airport or something like that.

Host: You mentioned death as one of the symptoms, sadly, but what are some other signs and symptoms?

Dr. Salvo: So you can have deadly heart rhythm that self-terminates. So meaning that it doesn't go all the way to your demise. And sometimes those things can be racing heart symptoms, exertional breathlessness, or passing out with no other explanation. And so one of the most important things when someone has a passing out episode is to make sure that their doctor does an analysis of what their heart pump function is.

If their heart pump function is strong, odds are, it was likely something like what we call a vasovagal episode where, you know, when someone's queasy at the sight of blood or a needle and they pass out. But if your doctor uncovers that your heart pump function is severely diminished, now it changes the entire story of where we need to go and how we need to prevent future catastrophes.

So if someone has a passing out episode and they're found to have a weakened heart muscle, that's really sort of the crux of what we make decisions. And finding out how your heart pump function is, is very easy. The most common thing is just doing an ultrasound of the heart. It's pretty much become the gold standard and even primary care office physicians have these in their office at times, and it's a very simple test to do.

Host: And how do you identify your potential risk factors?

Dr. Salvo: Making sure if we're talking about, you know, heart attack, leading to weakened heart and build up of scar tissue on the muscle, it's important to understand, you know, what your cholesterol is, what your blood pressure. Making sure that you've achieved a target goal. Certainly a family history is important and really we're talking about mothers, fathers, brothers, and sisters, as we make that determination, not so much distant relatives, although in some situations, if there's a whole swath of distant relatives who pass from sudden cardiac arrest, those are red flags that they should be alerted to other family members.

And sometimes someone may have no symptoms at all, but if the family history is so strong, it would be certainly wise to go seek an evaluation by a doctor. And they may even recommend seeing a specialist like myself, a Cardiac Electrophysiologist who specializes in sudden cardiac arrest.

Host: So someone with a family history, let's say both their parents had a heart attack, for instance, when should they start checking their heart health? Like at what age should they get, like you were saying ultrasounds?

Dr. Salvo: Exactly. So let's start simple with cholesterol, for example, you know, in your twenties, you should understand what your cholesterol is. Most Americans based on the typical American diet are not going to have a great cholesterol. Some people are, are blessed with a great cholesterol, but that's not the norm.

But occasionally what you'll find is that there'll be a familial cholesterol issue. I can tell you that one of my classmates in medical school, as we were doing our testing on ourselves and going through medical training found that he had a family history that he wasn't aware of in his cholesterol was off the charts and we were in our early twenties then. So, he was able to start medication and potentially change the course of his life going forward. So it, it, there really isn't too young of an age. I mean, certainly a pediatrician is probably not going to be looking for these things, but as you transition to adult medicine in your early 20s, just getting a basic cholesterol check is recommended so that you understand. And when they do that, they can check your, your blood pressure. Uncontrolled high blood pressure can affect young people and high blood pressure is actually one of the most common causes of a weakened heart. So if you have uncontrolled high blood pressure, the heart can tire out and become very weak.

And then that would put you at risk of sudden cardiac arrest. So these are things that can be done early. Certainly an ultrasound that may not be necessary in someone in their twenties, but certainly as you go into your thirties, if you've had a longstanding history of high blood pressure or cholesterol, even if those things have been treated, it's not unreasonable to do an ultrasound, to make sure that they haven't missed something or that there's not an underlying condition that was never picked up.

Host: So someone's family history really can impact their risk, right?

Dr. Salvo: Absolutely. When we talk about people who were finding these problems when they're in their twenties, those are almost always going to be family history. Now, as you transition into your fifties and sixties, genetics probably plays not so strong of a role, but certainly it does contribute. And then, you know, you worry about the wear and tear of, of age at that point. And so, you know, not having a great diet or a low-fat diet, not exercising, being overweight and, and not knowing what your underlying cardiac risks are; they become, more imperative as you age. And certainly you're going to be at higher risk of having one of these events, as you age, if these problems go unaddressed.

Host: Dr. Salvo, you mentioned some treatments of sudden cardiac arrest, like defibrillate, defibrillators and medicine. Are there any other treatments we should know about?

Dr. Salvo: Yeah, for sure. So there are, again, going back to prevention, prevention is going to be your biggest thing, and that's why heart health month is, is so important because it's focus is on prevention. So, you know, if, for example, someone is at risk of having a heart attack, a blocked artery or cholesterol buildup on their, on their small coronary arteries, testing can sometimes pick this up.

And sometimes if indicated, a stress test may, may lead to an intervention, changes the course of these blocked arteries, which can then prevent scar tissue, which can then prevent the heart from weakening, which can then prevent sudden cardiac arrest. So prevention is probably going to be one of your best modalities.

Now, if you're unfortunate where you've developed a weakened heart and you already fall within the higher risk bracket, then making sure that you're on the optimal, optimal medications. And if appropriate, a defibrillator may be an answer to prevent catastrophe. A defibrillator is like a pacemaker. It's implanted typically internally in the heart. It monitors your heart rhythm. And in the event that you have sudden cardiac arrest or sudden deadly heart rhythm, the device can analyze the rhythm and act appropriately to deliver high voltage electricity.

In the old days, before defibrillators, you had to depend upon bystanders CPR. Call 911, the ambulance would come. The paramedics would realize that you were in deadly heart rhythm, and as we've all seen on television, that's when they would defibrillate the patient with the paddles that, you know, kind of dramatic. We see in all the TV shows.

A defibrillator on the other hand, acts instantaneously. And the difference is, at least where we live an ambulance time can be anywhere between four to eight minutes. And to really get the best chance of resuscitating someone from sudden cardiac arrest, you have to get to them within four minutes because after non circulation, you start to develop things like brain damage, liver failure, kidney failure, as the organs don't get oxygen.

And so you have to act very quickly and that's where a defibrillator is superior to waiting for an ambulance to arrive. The numbers are not great. If you depend upon a 911 call and an ambulance to come and resuscitate you, your odds of surviving an out of hospital sudden cardiac arrest are less than 10%.

Now, if you've been identified at high risk and you get a defibrillator, now the chances go way up. And in fact, it's remarkable that the studies that were being done in the early two thousands, many of them were stopped because the arm of the patients that were getting defibrillators versus the study arm that were not, there was a disparate survival rate and they had to stop some of the, of the, the studies that were being done.

Host: And when you say defibrillator, do you mean the kind that are implanted or just the paddles on the outside?

Dr. Salvo: Right. So the one on the outside again is, is going to be a last resort. Whether it be from the paramedics, it, it has become better having them at places where people are at higher risk, at sporting events, gymnasiums shopping malls, where people are congregated. But if you're someone who has a weakened heart and you're at risk of sudden cardiac arrest, really having it implanted internally by a cardiac surgeon, like myself, is really going to be your best option.

It's going to be the most reliable, most effective, and the lowest risk of having, you know, collateral damage, like other organs that would, would not be perfused during the time that, you're awaiting to be resuscitated. So the example would be, external defibrillator, if someone opens one up at a gymnasium, puts it on the, on the patient, on the ground, it still takes a few minutes to fire it up, get the patches on, to figure out what the rhythm is.

And then, you know, depending on the defibrillator, it gives instructions and, you know, the person may have to defibrillate the person on the ground. As opposed to an internal defibrillator, which is automated, and can act instantaneously. They're really remarkable machines. And I would tell you the story of the implantable defibrillator is an amazing one.

And Israeli doctor, in the early 1980s, came up with the concept of being able to implant a defibrillator in a person to resuscitate them and prevent them from dying. The biggest hurdle was in the early days of computers then, getting the device to determine what was deadly heart rhythm and what was not meaning the device had to be pretty good at knowing when to deliver high voltage shock and the medical community sort of laughed at this and thought it was not possible.

And then it was approximately 1980 or 1981, I believe when the first one was implanted and the implant was large. I mean, it was like having a, a computer motherboard implanted in the abdomen, connected to wires that attached to the outside of the heart. Fast forward now to 2022, they've become very small, very petite, very reliable. The batteries can last 10 years. The wires can last you a lifetime and they're very smart. And they're programmable. We can monitor from home, remotely on our patients. And one of the biggest advances was making them compatible with MRI machines, so that if someone needed to have an MRI for an unrelated issue, these devices are now safe to go through MRI scanners. That was a big advancement within the last 10 years.

Host: That's amazing.

Dr. Salvo: It is, it really is advancement. And there are other ones now that we implant under the skin that can defibrillate without even being implanted internally. And sometimes those are great options for younger patients because the risk of infection and device failure, goes down that way.

But they're constantly revamping these and advancing the technology, making them smaller, better, last longer and more reliable all in the hope of reducing sudden cardiac arrest, which is really a catastrophic event.

Host: Sounds like it. Thank goodness all that research is paying off. So what should you do if you believe you're having a heart attack?

Dr. Salvo: So first, one of the biggest things is, is not to brush off the symptoms. And we know that because women in particular, don't have the typical symptoms of a heart attack with chest pain and whatnot, they are more likely to actually put off going to an emergency room or to you know, seek healthcare for this in general, thinking that it couldn't possibly be true.

And now we know that, that women will sometimes have, or oftentimes have symptoms that are different than, than men. But the trick is, if you think that you're having a heart attack act early, get early intervention on it. If you have sudden cardiac arrest, unfortunately there's not a lot you can do, because if you're a victim of this, you, you become incapacitated. On the flip side, however, I would tell you that as a community, as a, as a global community, as our country, we can do better by making sure that people are trained in CPR because CPR may be the only thing to have someone hang on long enough for an ambulance to arrive. And although the options aren't great, it really is the best option.

And so having as many people as possible trained in CPR, really can make a huge difference in the outcomes long-term in our, in our community. And I would tell you that in the last 10 years, there's been a big push to make this mandatory in high school education, that high schoolers would be trained in CPR.

It doesn't take long. And even if someone gets certified in CPR and they may not continue down that path of keeping it updated and recertifying it, if they come across an emergency somewhere later in life, the hope would be that they would recall at least something from their training to be able to help prevent a catastrophe.

Host: Right. And you talked about updating, because I've heard recently that there have been a lot of changes to how you perform CPR. So even if someone thinks they know how to do it, it, it's not a bad idea to maybe go to where, the Red Cross and get a refresher course for adults?

Dr. Salvo: Yes for sure. So the American Heart Association, the Red Cross are some of the organizations that you can go to. And you know, one of the big advancements has been doing hands only CPR. Uh, in the old days, we would say that you had to, you know, give breathing and then do pumping with the hands. And we've learned over the years that it's actually the pumping of the hands that circulates the blood through the chest, to the body.

And that really is the most important thing. So if you're going to focus on it, it would be those types of changes of moving to hands only CPR. And again, if somebody doesn't choose to continue certification later in life, at least if they've seen it once in their life, you would hope that if it's ever called into duty, it would be something that would, would help to avert a catastrophe until an ambulance or medical care can arrive. And I would also ask one other thing of, of our community. If you find yourself in a situation where you're going to be giving CPR., Find a bystander and tell them to not only call 911, but also see if there's a defibrillator anywhere nearby. You'd be surprised at how, how common they are now.

And if someone has the wherewithal to go and grab one off of a wall at a shopping mall, it might make all the difference in the world in resuscitating someone quickly. The, the schools now have them, sporting events have them. We recognize that where there's a lot of people congregating together, that's where they're most effective, but you have to know to ask for it. So those can be big game changers.

Host: Our workplace has them in every kitchen. I don't know who knows how to use them, but hopefully there are some people who already know how. Thank you so much, Dr. Salvo for sharing this invaluable information that could very well be lifesaving. We appreciate you.

Dr. Salvo: Thank you. Thank you for having me and get the word out. We hope this inspires people to be preventative about their healthcare, to identify their problems that they may have, and to maybe, uh, get trained in CPR so that we can help each other out and prevent catastrophe.

Host: Absolutely. That is Dr. Jared Salvo, an Electrophysiologist and Director of the Electrophysiology Lab at Bakersfield Memorial Hospital, a Dignity Health Hospital. To find out more, go to dignityhealth.org/bakersfield/heart. If you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you.

This is Hello Healthy, a Dignity Health Podcast. I'm Maggie McKay. Thank you for listening and be well.